We have long been concerned that the number of proton beam radiation therapy (PBRT) centers being built here in the USA was way higher than could be justified by the real demand for such services.

This article on the MedPage Today web site now reports the bankruptcy and closure — just 3 years after it opened — of the PBRT center at the Scripps Institute in San Diego, and it notes that several other centers are in financial difficulties. The primary reason is straightforward — neither the payer community nor most radiation oncologists have been convinced (yet) that PBRT is clinically superior to less costly forms of radiation therapy for the majority of patients who need radiation therapy.

There certainly are patients — most commonly children with certain forms of pediatric cancer — for whom PBRT is almost certainly a better type of radiation therapy. But at the end of the day it is the cost of PBRT that is the problem. It takes many millions of dollars to build an PBRT facility, and then, every year, it takes many more millions of dollars to maintain and operate that center. This makes it impossible, in the long term, to run such a center on even a break-even basis, unless either the clinical outcomes are demonstrably superior to those achievable with other forms of radiation therapy or that center is being financially supported by a major philanthropic donor or donors.

The bankruptcy of the Scripps center is the second case of a financial failure of a PBRT center here in the USA. The first was the center in Bloomington, Indiana, nearly 3 years ago now. Unfortunately the “New” Prostate Cancer InfoLink expects there to be at least three or four other such failures in the not too distant future.

There are many more questions implied by your comment. What constitutes new? Is proton therapy “new,” having been used for prostate cancer treatment for more than a quarter century? Maybe so, but who decides where the newness line is drawn? What kind of “proof of worth” would be acceptable, to whom must it be proven, and who must provide that proof? Who ultimately decides the “worth” or value of using a technology? According to whom must it be “worth the money?”

Perhaps you would like to be the one to decide whether a technology is new, whether sufficient proof of value has been provided to justify allowing it to be used? Maybe you would like to decide which technologies to allow? If not you, then who?

Your comment is nowhere near the bottom line, and I offer these questions as food for further thought.

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The “New” Prostate Cancer InfoLink is intended for informational purposes only. It is not engaged in rendering medical advice or professional services and is not a substitute for professional care. If you have or suspect you may have a health problem, please consult your healthcare provider.